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New study links body fat composition, not just BMI, to heart disease risk

Coronary heart disease Coronary heart disease
Coronary heart disease Coronary heart disease

What's new?

Higher fat mass, waist circumference, and waist-to-height ratio increase 10-year CHD risk, while higher fat-free mass significantly reduces this risk.

A landmark analysis from the Multi-Ethnic Study of Atherosclerosis (MESA) revealed that not all weight is equal when it comes to heart health. The study, which followed more than 6,800 adults between ages 45 and 85, found that body composition—specifically the balance between fat and muscle—may be a much more accurate predictor of coronary heart disease (CHD) than the commonly used body mass index (BMI).

For assessing obesity, BMI (a basic ratio of weight to height) has traditionally been the go-to metric. However, it does not differentiate between fat and muscle or provide insight into where fat is stored in the body. These limitations have aroused mixed results in studies exploring the link between obesity and cardiovascular events. To address this, the MESA researchers employed bioelectrical impedance analysis to estimate volunteers’ fat mass and fat-free mass (FFM) at the study’s start. They then analyzed these alongside other indicators like waist-to-height ratio, waist circumference, and BMI to see how each predicted the risk of experiencing a major CHD event over 10 years.

Key findings:

  • Fat Mass: A higher fat mass was clearly linked to an increased risk of coronary events. For every one standard deviation (SD) rise in fat mass, the risk of experiencing a hard CHD event—such as a non-fatal heart attack, resuscitated cardiac arrest, or death from coronary disease—increased by 64% (Hazard Ratio [HR]: 1.64).
  • FFM: In contrast, higher levels of muscle mass appeared to have a protective role. A one SD increase in FFM was linked with a 76% lower risk of hard CHD events (HR: 0.24).
  • Waist-to-Height Ratio: This simple yet powerful indicator of central fat accumulation was considerably related to heightened risk. Each SD increase in this ratio was linked to a 21% higher risk of a CHD event (HR: 1.21).
  • Waist Circumference: A larger waist size also predicted higher cardiovascular risk. Every SD rise was related to a 14% higher risk of hard CHD events (HR: 1.14).
  • Body Mass Index (BMI): Surprisingly, BMI did not markedly predict CHD risk in this population. A one SD rise in BMI corresponded to only an 8% increase in risk, which was not statistically significant (HR: 1.08).

The findings emphasize the importance of looking beyond weight alone when assessing cardiovascular risk. According to the study authors, strategies aimed at reducing fat mass—particularly around the waist—and increasing muscle mass could be more useful in preventing heart disease than simply focusing on weight loss.

These results bolster calls for clinicians to adopt substitute metrics, such as body composition analysis and waist-to-height ratio, in routine practice. Simple modifications, like including waist measurements during annual check-ups or using bioelectrical impedance analysis devices in primary care settings, could remarkably improve early detection of cardiovascular risk.

Source:

European Journal of Preventive Cardiology

Article:

Examining the relationship between anthropometric and body composition measures with coronary heart disease events: the multi-ethnic study of atherosclerosis

Authors:

Amier Haidar et al.

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